HIV-Infected Children and Nutrition: The Friend and The Foe

The impact of nutrition on HIV-infected children has been evaluated in multiple studies. Our review of the current trends of nutrition-related studies revealed that the focus has moved from simply the disease consequences of HIV to ensuring that antiretroviral therapy-treated children are well nourished to ensure growth and development. This update aims to present the state of the art regarding nutrition of HIV-infected children and the real potential for nutrition to serve as a dynamic therapy in this group. Recent World Health Organization reports indicate that the HIV/AIDS disease is curbing in incidence worldwide despite the high 1.8 million children, less than 15 years, reported in 2017. In addition, the literature supports the complexity and bidirectional relation between nutrition and HIV. HIV infection has a substantial effect on the nutritional status, in particular, the gastrointestinal side effects, which, in turn, have a profound impact on HIV infection. Advances in the field have transformed the course of the disease into a chronic illness, where more attention was given to lifestyle and quality of life including nutrition. However, achievement of food security, nutrition accessibility, and appropriate handling of nutrition-related complications of HIV infection are remarkable challenges, particularly, in resource poor environments, where most HIV infections exist

A Catalytic Mechanism for Cysteine N-Terminal Nucleophile Hydrolases, as Revealed by Free Energy Simulations

The N-terminal nucleophile (Ntn) hydrolases are a superfamily of enzymes specialized in the hydrolytic cleavage of amide bonds. Even though several members of this family are emerging as innovative drug targets for cancer, inflammation, and pain, the processes through which they catalyze amide hydrolysis remains poorly understood. In particular, the catalytic reactions of cysteine Ntn-hydrolases have never been investigated from a mechanistic point of view. In the present study, we used free energy simulations in the quantum mechanics/molecular mechanics framework to determine the reaction mechanism of amide hydrolysis catalyzed by the prototypical cysteine Ntn-hydrolase, conjugated bile acid hydrolase (CBAH). The computational analyses, which were confirmed in water and using different CBAH mutants, revealed the existence of a chair-like transition state, which might be one of the specific features of the catalytic cycle of Ntn-hydrolases. Our results offer new insights on Ntn-mediated hydrolysis and suggest possible strategies for the creation of therapeutically useful inhibitors

A Primer to the Diagnostic and Clinical Utility of Spleen Stiffness Measurement in Patients With Chronic Liver Disease

Content available: Author Audio Recordin

Prevalence of High-risk Non-alcoholic Steatohepatitis (NASH) in the United States: Results from NHANES 2017-2018.

BACKGROUND & AIMS The population prevalence of high-risk non-alcoholic steatohepatitis (NASH), defined as NAFLD activity score ≥4 and fibrosis stage ≥2, is unknown. FAST score, calculated using LSM and CAP values from FibroScan® and AST levels, is a validated algorithm to identify individuals with high-risk NASH. We estimated the prevalence of high-risk NASH using the FAST score in the U.S. POPULATION METHODS Data were derived from the National Health and Nutrition Examination Surveys 2017-2018, which included a total of 4218 adults with valid elastography measurements. FAST scores of ≥0.35 (sensitivity 90%) and ≥0.67 (specificity 90%) were used to identify adults with high-risk NASH in the general population. RESULTS At 90% sensitivity for the FAST score, the prevalence of age-adjusted high-risk NASH was 5.8% and was higher among men (8.2% vs. 3.6% in women) and in Hispanics (9.2% vs. 5.8% non-Hispanic (N.H.) Asians, 5.2% in N.H. Whites, and 3.8% in N.H. Blacks). The prevalence of high-risk NASH was 11.7% in those with metabolic syndrome (MetS) and 22.5% in individuals with type 2 diabetes mellitus (T2DM). At 90% specificity for the FAST score, the prevalence of age-adjusted high-risk NASH was 1.2% and was higher among men (1.7% vs. 0.8% in women) and in Hispanics (2.2% vs. 1.0% in N.H. Asians, 0.9% in N.H. Whites, and 0.4% in N.H. Blacks). The prevalence of high-risk NASH was 3.4% in those with MetS and 8.7% in adults with T2DM. CONCLUSIONS We estimate at least 2 million adults have high-risk NASH in the US. Moreover, the prevalence of high-risk NASH among individuals with T2DM is higher ranging between 8.7% and 22.5%, supporting the case for coordinated case-finding and management

High-quality diet, physical activity, and college education are associated with low risk of NAFLD among the US population

Background and Aims The effects of diet quality (DQ), physical activity (PA), and socioeconomic status (SES) on the risk of NAFLD are unclear. We examined the association among DQ, PA, SES, and NAFLD risk. Approach and Results This is a cross-sectional analysis of the National Health and Nutrition Examination Surveys, 2017–2018, which included 3589 participants with reliable information on vibration-controlled transient elastography (VCTE) measurements, 24-h dietary recalls, PA, and SES. DQ was assessed by the Healthy Eating Index (HEI)-2015. PA was determined by the Global Physical Activity Questionnaire. SES was assessed by the educational attainment and family poverty income ratio (PIR). Risk of NAFLD was considered by means of a composite outcome using VCTE measurements: non-NAFLD versus NAFLD without clinically significant fibrosis (CSF) versus NAFLD with CSF. The NAFLD risk was lower in physically active (≥600 metabolic equivalent of task [MET] min/week) versus inactive participants ( 56.64) was associated with a lower risk of NAFLD (OR: 0.58, p < 0.01) compared with a non-HQD. The lowest NAFLD risk was observed in those physically active with HQD (OR: 0.43, p < 0.01). Body mass index and waist circumference significantly mediated the effect of DQ and PA on NAFLD risk. Education (college or above) (OR: 0.65, p = 0.034), but not PIR, was associated with a reduced NAFLD risk. HQD and increased PA partially mediated the effect of education on NAFLD risk. The total effect of education on NAFLD risk mediated by DQ was 29% and by PA was 8%. Conclusions HQD, increased physical activity, and college education were associated with lower NAFLD risk in the US population

Attendance at a Transitional Liver Clinic May Be Associated with Reduced Readmissions for Patients with Liver Disease

Introduction: Patients with liver disease have high rates of early hospital readmission, but there are no studies of effective, scalable interventions to reduce this risk. In this study, we examined the impact of a Physician Assistant (PA)-led post-discharge Transitional Liver Clinic (TLC) on hospital readmissions. Methods: We performed a cohort study of all adults seen by a hepatologist during admission to a tertiary care center in 2019 (excluding transplant patients). We compared those who attended the TLC with those who did not, with respect to 30-day readmission and mortality. Propensity score-adjusted modeling was used to control for confounding. Results: Of 498 patients, 98 were seen in the TLC; 35% had alcoholic liver disease and 58% had cirrhosis. Attendees were similar to non-attendees with respect to demographics, liver disease characteristics and severity, comorbidities, and discharge disposition. Thirty-day cumulative incidence of readmissions was 12% in TLC attendees, compared with 22% in non-attendees (P = .02), while 30-day mortality was similar (2.0% vs 4.3%; P = .29). In a model using propensity score adjustment, TLC attendance remained associated with reduced readmissions (subhazard ratio 0.52; 95% confidence interval, 0.27-0.997; P = .049). The effect of TLC was greater in women compared with men (P = .07) and in those without chronic kidney disease (P = .02), but there were no differences across other subgroups. Conclusions: Patients with liver disease seen in a PA-led TLC may have a significant reduction in the 30-day readmission rate. Randomized trials are needed to establish the efficacy of PA-led post-discharge transitional care for this population

social objects from intentionality to documentality

What keeps society together? A popular answer has been that collective intentionality lies at the bottom of all manifestations of social reality. Several problems and criticisms have arisen against such a view in the very recent literature. An alternative approach replaces the notion of collective intentionality with the notion of “documentality”: the basis of social reality is the inscription of acts. The multifariousness of perspectives and topics addressed in the present volume witnesses the great vitality of the debate. Our guess is that such vitality is destined to increase in parallel to, and partly because of, the progressive complexification of contemporary societies

Recommendation of RILEM TC 264 RAP on the evaluation of asphalt recycling agents for hot mix asphalt

This recommendation is based on the results of an inter-laboratory study organised by the RILEM technical committee TC 264-RAP ‘‘Asphalt Pavement Recycling’’—Task Group 3 (TG3) focusing on Asphalt Binder for Recycled Asphalt Mixture. The TG3 aimed to evaluate the effect of a specific family of materials known as asphalt recycling agent (ARA) on the aged binder under different configurations. Even though ageing is an irreversible phenomenon, effective ARA must have the capability to improve the flexibility of the bituminous materials and their resistance against cracking susceptibility with no adverse effect on the rutting resistance of pavements containing reclaimed asphalt. A total of 17 participating laboratories analysed the properties of binder blends composed of aged binder from reclaimed asphalt in three different contents (60, 80, 100%), ARA and virgin binder. The physical properties of the blends were thoroughly evaluated through traditional and rheological binder testing. This recommendation proposes to restore the original material properties at low and intermediate temperatures (i.e. cracking resistance) while balancing the high-temperature characteristics (i.e. rutting susceptibility) with durable impact throughout the progression of ageing phenomena. Therefore, useing of the Dynamic Shear Rheometer is foreseen as a more suitable and sustainable means to evaluate binder blends containing an asphalt recycling agent. Compared with conventional testing, the proposed approach requires fewer materials while resulting in a faster experimental procedure with one single test

Effect of Aging on the Rheological Properties of Blends of Virgin and Rejuvenated RA Binders

The use of rejuvenators has seen a consistent increase over the years in the asphalt pavement industry. This is due to the need for maximizing the demand for incorporating a higher amount of Reclaimed Asphalt (RA) in the pavement asphalt mixtures. In order to tackle this challenge, the Task Group 3, focusing on asphalt binders and additives, of the RILEM TC RAP conducted an interlaboratory activity to evaluate the effect of aging on blends of virgin and rejuvenated RA binders. A set of conventional tests including penetration value at 25 °C, softening point temperature and rheological measurements by means of Dynamic Shear Rheometer (DSR) were selected to involve a large number of participants. A binder, recovered from field RA, was treated with a bio-based rejuvenator and blended with a virgin binder to simulate recycling at three different percentages 60 %, 80 %, and 100 %. These blends, as well as the pure virgin binder, were next short and long term aged and tested to evaluate the changes in the corresponding properties. Relatively consistent results were obtained for the entire set of blends. The aging of combined rejuvenated RA and virgin binders was comparable to that experienced for the pure virgin binder. DSR data provided a more precise evolution of the impact of aging on the materials